Costos directos en el tratamiento del pie diabético Unidad de Pie Diabético. Hospital de Clínicas. Universidad de la República

En el mundo un paciente diabético gasta entre dos y tres veces más que el no diabético. El pie diabético disminuye la calidad de vida, aumenta la morbimortalidad y la carga económica del sistema de salud. Objetivo: comunicar la investigación realizada sobre costos directos en el tratamiento de la úlcera del pie diabético. Material y método: estudio observacional, descriptivo, retrospectivo de pacientes asistidos en la Unidad de Pie del Hospital de Clínicas, Universidad de la República, entre octubre de 2014 y septiembre de 2016. Se estimaron gastos directos del tratamiento ambulatorio e internación a través de información de la historia clínica. El horizonte de tratamiento fue de tres meses. Se calcularon los gastos en unidades reajustables (UR), pesos y dólares. Los gastos se actualizaron a octubre del 2022 utilizando el índice de precios al consumo (IPC), ajustado a la tasa de inflación acumulada. Resultados: incluimos 49 pacientes, 11 mujeres y 38 hombres, edad promedio 61,5 años. El gasto general fue mayor a 400.000 dólares, con el mayor costo en gastos de internación. El gasto total promedio por paciente fue de 8.799 dólares. El tratamiento convencional fue 3.707,93 dólares, la amputación mayor 32.003,61 dólares y amputación menor 12.385,34 dólares. El gasto en internación fue muy superior al del paciente ambulatorio. En emergencia, 28 pacientes gastaron 4.396 dólares. El incremento de costos al año 2022 fue de 37,45%, suponiendo un gasto general de 16.682.993,4 pesos o 410.830,2 dólares. Conclusión: primera evaluación en nuestro país de estimación de gastos en pie diabético. El costo de la úlcera genera una carga económica notoria y en aumento. La gravedad inicial de la úlcera determina ingresos con elevados costes. Los gastos de internación y amputaciones representan la mayor erogación económica.

On a global scale, a diabetic patient incurs healthcare expenses that are 2 to 3 times higher than those of a non-diabetic individual. Diabetic foot syndrome reduces the quality of life, increases morbidity and mortality, and places an economic burden on the healthcare system. Objective: Communicating the research conducted on direct costs in the treatment of diabetic foot ulcers. Method: Observational, descriptive, retrospective study of patients treated at the Foot Unit of the Hospital de Clínicas (UDELAR) between October 2014 and September 2016. Direct treatment costs for outpatient care and hospitalization were estimated using information from the medical records. The treatment horizon extended over a period of 3 months. Expenses were calculated in readjustable units, Uruguayan pesos (UYU), and United States dollars (USD). Expenses were updated to October 2022 using the Consumer Price Index (IPC) adjusted for the cumulative inflation rate. Results: 49 patients were included in the study: 11 women and 38 men, average age was 61.5 years old. The overall expenditure exceeded 400,000 USD, with the highest cost attributed to hospitalization expenses. The average total expenditure per patient amounted to 8,799 USD. The cost of conventional treatment was 3,707.93 USD, major amputation represented USD 32,003.61, and minor amputation USD 12,385.34. Hospitalization expenses significantly exceeded those of outpatient care. In the emergency department, 28 patients spent USD 4,396. The increase in costs by the year 2022 amounted to 37.45%, resulting in a total expenditure of UYU 16,682,993.4 (Uruguayan pesos) or USD 410,830.2. Conclusions: It was the first assessment in our country to estimate diabetic foot costs. The cost of ulcer management imposes a significant and increasing economic burden. The initial severity of the ulcer results in hospitalization which implies high associated costs. Hospitalization and amputation costs constitute the most substantial economic expenditure.

Em todo o mundo, um paciente diabético gasta entre 2 e 3 vezes mais do que um paciente não diabético. O pé diabético reduz a qualidade de vida, aumenta a morbimortalidade e a carga económica no sistema de saúde. Objetivos: Comunicar os resultados da pesquisa realizada sobre os custos diretos no tratamento das úlceras do pé diabético. Materiais e métodos: Estudo observacional, descritivo e retrospectivo de pacientes atendidos na Unidade de Pie do Hospital de Clínicas (UDELAR), entre outubro de 2014 e setembro de 2016. Foram estimados gastos diretos com tratamento ambulatorial e internação, por meio de informações do prontuário do paciente. O período de tratamento estudado foi de 3 meses. As despesas foram calculadas em Unidades Ajustáveis, em pesos uruguaios (UYU) e em dólares norte-americanos (USD). As despesas foram atualizadas para outubro de 2022 pelo Índice de Preços ao Consumidor (IPC) ajustado à inflação acumulada. Resultados: Foram incluídos 49 pacientes: 11 mulheres e 38 homens com idade média de 61,5 anos. A despesa global foi superior a US$ 400.000, com o maior custo em despesas de hospitalização. A despesa total média por paciente foi de US$ 8.799. Os custos por tratamento foram: Tratamento convencional US$ 3.707,93 USD, amputação maior US$ 32.003,61 e amputação menor US$ 12.385,34. O gasto com internação foi muito superior ao do ambulatório. No atendimento de emergência 28 pacientes gastaram US$ 4.396. O aumento dos custos até 2022 foi de 37,45%, assumindo uma despesa geral de UY$ 16.682.993,4 ou US$ 410.830,2 USD. Conclusão: Esta é a primeira avaliação de estimativa de gastos com pé diabético realizada no Uruguai. O custo das úlceras gera uma carga económica notável e crescente. A gravidade inicial da úlcera determina internações com custos elevados. As despesas com hospitalização e amputação representam o maior gasto financeiro.

Socio-Demographic, Clinical and Diabetes Status of Foot Ulcer Patients

Background: Foot ulcers are considered as a serious complication, especially for patients with diabetes. People with diabetes and people with peripheral vascular disease are more likely to develop foot ulcers. If an infection occurs in an ulcer and is not treated in the proper way, it can develop into cellulitis, osteomyelitis, or gangrene that may require some part of the toe, foot, or lower leg to be amputated. The aim of this study was to find the socio-demographic, clinical, and diabetes status of foot ulcer patients. Material & Methods: This prospective observational study was conducted in the Department of Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, during the period from March 2012 to August 2012. In total 100 patients with foot ulcers in the different surgical units of the mentioned hospital were enrolled in this study as study subjects. Data from the study regarding age, sex, occupation, smoking habit, and socio-demographic condition were recorded in the prescribed questionnaire. The purposive sampling technique was used for this study. All data were processed, analyzed, and disseminated using MS Excel and SPSS version 23 programs as necessary. Results: In this study, the male-female ratio of the participants was 2:1. The maximum number of patients (42%) were from the age of 51-60 years and the highest number of patients were housewives (28%), followed by farmers (22%). Among the total male patients, 87.88% were smokers. Low HDL was found in 51% of patients and 68% of patients had been suffering from diabetes mellitus,18% from Buerger’s disease and 6% from atherosclerosis, and 8% from malignant foot ulcer. Most of the diabetic patients (95.59%) were hyperglycemic on admission and 55.88% had diabetes for 6-10 years. On admission, 3 patients (4.41%) had controlled blood sugar and 65 patients (95.59%) had uncontrolled blood sugar. Conclusion: The frequency of foot ulcers among the male population was higher than that in females. Concerning occupation of the patients, housewives and farmers were the most prevalent. Smokers were most affected groups among the study population. Pre-diagnosed diabetes mellitus for a long period was one of the major clinical issues in most of the patients. Uncontrolled blood sugar was also seen in majority of the patients regarding clinical background.

Papel de la neuropatía diabética en la aparición y desarrollo del síndrome del pie diabético / Role of Diabetic Neuropathy in the Onset and Development of Diabetic Foot Syndrome

Introducción: La neuropatía diabética es la complicación más frecuente de la diabetes mellitus y una de sus posibles consecuencias es el síndrome del pie diabético. Los médicos del primer nivel de atención deben conocer el comportamiento clínico de la neuropatía diabética y, sobre todo, como influye en la aparición y desarrollo del síndrome del pie diabético. Objetivo: Describir el papel de la neuropatía diabética en la aparición y desarrollo del síndrome del pie diabético. Métodos: Para la obtención de la información se utilizaron como motores de búsqueda de información científica los correspondientes a Scielo, Pubmed, y Google Académico. Se usaron como palabras clave: diabetes mellitus; neuropatía diabética; pie diabético; síndrome de pie diabético; úlcera de pie diabético; ataque de pie diabético. Se evaluaron diferentes trabajos de revisión, investigación y páginas web, y se excluyeron los artículos que tuvieran más de 10 años de publicados, en idiomas diferentes al español, portugués e inglés y que no se refirieran al tema de estudio a través del título. Esto permitió la cita de 45 referencias bibliográficas. Conclusiones: La neuropatía diabética constituye el principal factor de riesgo en la aparición y desarrollo del síndrome del pie diabético, sobre todo cuando se asocia a artropatía (defectos podálicos), enfermedad vascular periférica y/o sepsis. El control de la glucemia, la detección temprana del pie de riesgo y el cuidado preventivo de los miembros inferiores, repercutirá favorablemente en la salud y bienestar del paciente(AU)

Introduction: Diabetic neuropathy is the most frequent complication of diabetes mellitus and one of its possible consequences is diabetic foot syndrome. First level of care physicians should know the clinical behavior of diabetic neuropathy and, above all, how it influences the appearance and development of diabetic foot syndrome. Objective: To describe the role of diabetic neuropathy in the appearance and development of diabetic foot syndrome. Methods: To obtain the information, SciELO, PubMed and Google Scholar were used as search engines for scientific information. The keywords used were: diabetes mellitus; diabetic neuropathy; diabetic foot; diabetic foot syndrome; diabetic foot ulcer; diabetic foot attack. Different review papers, research papers and web pages were evaluated and articles that were more than 10 years old and published in languages other than Spanish, Portuguese and English and that did not refer to the subject of the study through the title were excluded. This allowed the citation of 45 bibliographic references. Conclusions: Diabetic neuropathy constitutes the main risk factor in the appearance and development of diabetic foot syndrome, especially when associated with arthropathy (foot defects), peripheral vascular disease and/or sepsis. Glycemic control, early detection of the foot at risk and preventive care of the lower limbs will have a favorable impact on the patient's health and well-being(AU)

Clinical Observation on Treatment of Diabetic Foot Ulcer of Wagner Grade 1-2 by Compound Huangbai Liquid Fomentation / 中国实验方剂学杂志

ObjectiveTo observe the clinical efficacy of compound Huangbai liquid fomentation on diabetic foot ulcer of Wagner grade 1-2. MethodPatients were classified into the observation group and control group， with 41 cases in either group. The observation group received routine therapy and compound Huangbai liquid fomentation， while the control group was treated by routine therapy and medical silver nanoparticles-containing dressing. Ulcer area， ulcer depth， traditional Chinese medicine （TCM） syndrome score， ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， epidermal growth factor， advanced glycation end product， high-sensitivity C-reactive protein， interleukin-6， erythrocyte sedimentation rate， and adverse events were observed before and after treatment in two groups. ResultAfter treatment， the ulcer area， ulcer depth， TCM syndrome score， vascular endothelial growth factor， epidermal growth factor， advanced glycation end product， high-sensitivity C-reactive protein， interleukin-6（IL-6）， and erythrocyte sedimentation rate were lower than those before treatment in two groups （P<0.05）， and ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， and epidermal growth factor were higher than those before treatment in two groups （P<0.05）. After treatment， the ulcer area， ulcer depth， TCM syndrome score， advanced glycation end product， high-sensitivity C-reactive protein， IL-6， and erythrocyte sedimentation rate were lower in the observation group than in the control group （P<0.05）， and ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， and epidermal growth factor were higher in the observation group than in the control group （P<0.05）. The clinical efficacy of observation group was better than that of the control group （P<0.05）. There was no significant difference in the incidence of adverse events and endpoint events between two groups. ConclusionCompound Huangbai liquid fomentation is effective for diabetic foot ulcer of Wagner grade 1-2， as it is beneficial to the healing of the ulcer. This study provides clinical evidence for the further promotion of Chinese medicine fomentation.

Úlceras de pie diabético y plasma rico en plaquetas / Healing of diabetic foot ulcers with platelet-rich plasma

Introducción: El plasma rico en plaquetas (PRP) se encuentra en desarrollo desde los años 80, asociado con aplicaciones en medicina cardíaca, traumatológica y dermatológica. El PRP es una preparación autóloga, con una concentración de plaquetas por sobre el valor normal en sangre periférica, que se obtiene a partir de su centrifugación siguiendo diferentes protocolos que fueron valorados en distintas revisiones sistemáticas. El plasma luego se activa con trombina o cloruro cálcico, o por lisis física (ultrasonido o frizado). El PRP contiene factores de crecimiento, citoquinas y proteínas de adhesión que, al aplicarse en la lesión, favorecen la hemostasia, la síntesis de tejido conectivo y la revascularización. El producto se aplica en solución o gel. Se intentaron diferentes clasificaciones del PRP para estandarizarlo, sin éxito. Se conceptualizó la receta del PRP para aplicación clínica, que presentó las siguientes características: valores altos de plaquetas, disminución de la contaminación de glóbulos rojos, presencia de neutrófilos y leucocitos para el éxito terapéutico. Protocolo y casos: Se presenta el protocolo de preparación de PRP de centrifugación única de 7 minutos a 1400 rpm, con activación por medio de gluconato de calcio según la siguiente proporción: 3 ml plasma/0.4 ml gluconato cálcico. Además, se informan tres casos de úlceras de pie diabético de nuestra institución. Conclusión: El PRP no presenta complejidad en su preparación y aplicación, por lo que es factible de realizar en el primer nivel de atención que cuente con los recursos materiales y profesionales con conocimiento en el abordaje de heridas crónicas.

Introduction: Platelet-rich plasma (PRP) has been under development since the 1980s, associated with applications in cardiac, traumatological, and dermatological medicine. PRP is an autologous preparation with a platelet concentration above the normal value in peripheral blood that is obtained from its centrifugation following different protocols that were evaluated in different systematic reviews. The plasma is then activated with thrombin or calcium chloride, or by physical lysis (ultrasound or friz). PRP contains growth factors, cytokines, and adhesion proteins that, when applied to the lesion, favor hemostasis, connective tissue synthesis, and revascularization. The product is applied in solution or gel. Different classifications of the PRP were used with the intention of standardizing the procedure without success. The PRP recipe for clinical application was conceptualized. It presented the following characteristics: high platelet values, decreased red blood cell contamination, presence of neutrophils and leukocytes for therapeutic success. Protocol and cases: The PRP preparation protocol for single centrifugation for 7 minutes at 1400 rpm with activation through calcium gluconate is presented according to the following ratio: 3 ml plasma/0.4 ml of calcium gluconate. Three cases of diabetic foot ulcers from our institution are reported. Conclusion: The PRP does not present complexity in its preparation and application, so it is feasible to perform it in the first level of care that has the material and professional resources with knowledge in the approach to chronic wounds.

Tecnologia social para a prevenção de úlceras em pés de pessoas diabéticas / Social technology for the prevention of foot ulcers in diabetic people / Tecnología social para la prevención de úlceras del pie en personas diabéticas

Objetivo:Descrever a construção de tecnologia social para prevenção de úlceras em pés de pessoas diabéticas. Método:Estudo de abordagem qualitativa, caráter descritivo-exploratório, corresponde a uma pesquisa ação que foi realizada com 11 enfermeiras integrantes da Rede de Atenção Primária à Saúde do Município de Salvador, Bahia, Brasil. Esta pesquisa foi norteada pelaperspectiva Crítico-Libertadora de Paulo Freire. Resultados:A construção da tecnologia social para prevenção de úlceras em pés de pessoas diabéticas se deu com a participação de enfermeiras atuantes na APS, as quais coletivamente propuseram os elementos necessários para compor a planilha online de rastreio no Google Drive. Tais elementos abarcam as necessidades de identificação do paciente, conhecimento da história clínica, acompanhamento da diabetes e suas possíveis complicações, itens para o rastreio, além de determinar encaminhamentos. Considerações finais:A tecnologia social se constitui como facilmente replicável, de baixo custo e com relevância social. Sua utilização alcança não apenas enfermeiras, mas abrange outros profissionais de saúde, assim como tem impacto direto na qualidade de vida de pessoas com diabetes.

Objective: To describe the construction of social technology for the prevention of foot ulcers in diabetic people. Method: Study with a qualitative approach, with a descriptive-exploratory character, corresponding to action research that was carried out with 11 nurses who are members of the Primary Health Care Network in the city of Salvador, Bahia, Brazil. This research was guided by Paulo Freire's Critical-Liberating perspective. Results:The construction of social technology for the prevention of foot ulcers in diabetic people took place with the participation of nurses working in the PHC, who collectively presented the necessary elements to compose the online tracking worksheet on Google Drive. Such elements include the needs for patient identification, knowledge of the clinical history, monitoring of diabetes and its possible complications, items for tracking, in addition to determining the referral.Final considerations: Social technology is easily replicable, low cost and socially popular. Its use reaches not only nurses, but also other health professionals, as well as having a direct impact on the quality of life of people with diabetes.

Objetivo: Describir la construcción de tecnología social para prevenir úlceras en los pies en personas diabéticas. Método:Estudio con enfoque cualitativo, de carácter descriptivo-exploratorio, correspondiente a una investigación-acción que se realizó con 11 enfermeros integrantes de la Red de Atención Primaria de Salud del Municipio de Salvador, Bahía, Brasil. Esta investigación estuvo guiada por la perspectiva Crítico-Liberador de Paulo Freire. Resultados:La construcción de tecnología social para prevenir úlceras del pie en personas diabéticas se realizó con la participación de enfermeros que trabajan en la APS, quienes colectivamente propusieron los elementos necesarios para la composición de la hoja de seguimiento en línea en Google Drive. Estos elementos cubren las necesidades de identificación del paciente, conocimiento de la historia clínica, seguimiento de la diabetes y sus posibles complicaciones, elementos de tamizaje, además de determinar derivaciones. Consideraciones finales:La tecnología social es fácilmente replicable, de bajo costo y socialmente relevante. Su uso llega no sólo al personal de enfermería, sino también a otros profesionales de la salud, además de tener un impacto directo en la calidad de vida de las personas con diabetes.

LED phototherapy in tissue repair of chronic wounds in people with diabetes: a systematic review / Fototerapia LED en la reparación de tejidos de heridas crónicas en personas con diabetes: una revisión sistemática / Fototerapia com LED no reparo tecidual de feridas crônicas em pessoas com diabetes: revisão sistemática

ABSTRACT Objective: To identify scientific evidence of LED photobiomodulation in the treatment and tissue repair of chronic wounds in people with Diabetes Mellitus, types I and II. Method: Systematic review conducted from September/2021 to April/2022 in PubMed, LILACS, SCIELO, COHRANE, EMBASE and Web of Science. Randomized and observational clinical trials using LED in wound healing in diabetics, published between 2015 and 2022 were included. Data were descriptively analyzed with title/abstract screening, full text articles reading and definitive selection after meeting the predefined inclusion and exclusion criteria. Results: Fromthe total of 840 references, eight articles were selected, that evaluated the effectiveness of LED phototherapy in wounds of diabetic patients. Conclusion: LED light proved to be beneficial in tissue repair, with increased production in collagen and fibroblasts, angiogenesis, reduction of inflammation and, consequently, a decrease in lesion size.

RESUMEN Objetivo: Identificar evidencias científicas de fotobiomodulación con LED en el tratamiento y reparación de tejidos de heridas crónicas en personas con Diabetes Mellitus, tipos I y II. Método: Revisión sistemática realizada de septiembre/2021 a abril/2022 en PubMed, LILACS, SCIELO, COHRANE, EMBASE y Web of Science. Se incluyeron ensayos clínicos aleatorizados y observacionales con uso de LED en la cicatrización de heridas en diabéticos, publicados entre 2015 y 2022. Los datos fueron analizados descriptivamente con selección de título/resumen, lectura de artículos a texto completo y selección definitiva después de cumplir con la inclusión e inclusiones ex - predefinidas. Resultados: Del total de 840 referencias encontradas, se seleccionaron ocho artículos que evaluaron la efectividad de la fototerapia LED en heridas de pacientes diabéticos. Conclusión: La luz LED demostró ser beneficiosa en la reparación de tejidos, con aumento de la producción de colágeno y fibroblastos, angiogénesis, reducción de la inflamación y, en consecuencia, disminución del tamaño de la lesión.

RESUMO Objetivo: Identificar evidências científicas da fotobiomodulação com LED no tratamento e reparo tecidual em feridas crônicas de pessoas com Diabetes Mellitus, tipo I e II. Método: Revisão sistemática realizada de setembro/2021 a abril/2022 na PubMed, LILACS, SCIELO, COHRANE, EMBASE e Web of Science. Incluídos ensaios clínicos randomizados e observacionais utilizando LED na cicatrização de feridas em diabéticos, publicados entre 2015 a 2022. Os dados foram analisados descritivamente com triagem de título/resumo, leitura dos artigos em texto completo e seleção definitiva após atender aos critérios de inclusão e exclusão pré-definidos. Resultados: Do total de 840 referências encontradas, foram selecionados oito artigos que avaliaram a eficácia da fototerapia LED em feridas de pacientes diabéticos. Conclusão: A luz LED mostrou-se benéfica no reparo tecidual, com aumento na produção de colágeno e fibroblastos, angiogênese, redução da inflamação e consequentemente, diminuição no tamanho da lesão.

Serum Procalcitonin (PCT) - Is there a Role as an Early Biomarker in Infected Diabetic Foot Ulcer (IDFU) Patients?

@#Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and Creactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL. Conclusion: PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.

Two Arm Single-blind Parallel Randomized Controlled Trial Effects of Health Education Intervention on Foot Self-care Behavior Among Diabetic Patients: Study Protocol

@#Introduction: Diabetes is a chronic illness and it has a significant impact on health. Behavioral interventions theory could improve self-care practices of the foot among patients with diabetic. Behavioral interventions could prevent the risk of foot problems. This trial aims at determining the effect of patient education intervention on foot self-care behavior and clinical outcomes among diabetes patients. Methods: The study is a two-arm single-blinded randomized controlled trial which will be conducted in the Federal Medical Centre (FMC) Owerri, Imo state, Nigeria involving 160 diabetic patients. A central computer-generated randomization list will be generated. Sequentially numbered sealed opaque envelopes will be used to determine concealment. The sample size is 160; therefore 80 participants will receive three sessions of patient education in addition to usual care (intervention group) for three and six months while another 80 participants (control group) will receive only usual care and will receive health education after the study is completed. The outcome of the intervention effectiveness is measured by modified version of Diabetes foot Self-Care Behavior Scale (DFSBS). Discussion: Our hypothesis is that based on the Health Belief Model, patient education intervention can improve foot self-care behavior in the intervention group. Data collection will be done at baseline, and at three- and six-months post intervention. Trial Registration: The Clinical Trials Registry- India (CTRI), Reference no CTRI/2021/06/034311.

Improving Foot Self-care Practices Through Health Education Intervention Programs Among Diabetic Patients: A Systematic Review

@#Introduction: Diabetic foot ulcers (DFUs) remain one of the greatest significant problems of diabetes mellitus. It is a cause of main suffering and expenses for patient, and financial problem on health facilities and public. One of the strategies to overcome DFU is through health education to prevent foot ulcer, which focused in promoting foot self-care. To reach this aim, researchers had applied different educational approaches. This systematic review is to evaluate various types of educational programs in terms of its method of delivery and effectiveness. Methods: The search involved various databases; EBSCOHOST, MEDLINE, CINAHL, Cochrane library, ScienceDirect, PubMed, SAGE SringerLink, Web of Science and Wiley Online Library. It was limited to full text research articles that report intervention studies, and the writte up in English Language, the publication was from 2005 to 2021. The key words were “diabetes”, “diabetes foot”, “foot self-care”, health education and “interventions”. Results: Twenty studies were involved in this review. Nine studies were randomized controlled trials (RCTs), while eleven reported non-randomized controlled trials (NRCTs). Conclusion: There are evidences that foot care education improves foot care and diabetic foot problems. Various health education approaches, for instance foot assessment, discussion, counseling, homebased visitation and telephone calls have been shown to be effective in improving educational programs. Studies in the future should focus on RCTs in different sites and apply follow-up of long duration to provide better recommendations to healthcare practitioners on effective educational interventions to prevent DFUs.

Transcutaneous oxygen tension and ankle brachial pressure index as predictors of outcome in diabetic foot

Background: Diabetic foot ulcer poses a serious threat to patients with Diabetes as the presence of an ulcer further significantly increases the risk of an amputation. Aim and Objectives: The present study was undertaken to assess: Correlation of transcutaneous oxygen tension (TcpO2) and ankle brachial pressure index (ABI) in outcome of diabetic foot and severity of neuropathy by grades. Materials and Methods: About 30 patients of Type 2 Diabetes Mellitus with foot lesions and 30 healthy controls were selected after obtaining informed consent and ethical committee clearance. Subjects were recruited taking into consideration various inclusion and exclusion criteria. The subjects were assessed for the following parameters: Vibration perception, hot, and cold perception along with TcpO2 and ankle brachial pressure index (ABI). The test results were compared within the two groups of cases, that is, Group I: Healed ulcer and Group II-Non-healed ulcer. The results of the two groups were compared with 30 healthy controls also. Results: Males were predominant (66.67%) compared to females (33.33%) in the diabetic foot patients. Severe derangements in the sensory modalities were found as observed by the bilaterally reduced values of vibration perception, hot perception and cold perception tests when diabetic foot patients were compared to controls. The values, however, were not significantly different between the two groups of patients of diabetic foot. The values of TcPO2 and ABI were bilaterally reduced in the cases as compared to controls and amongst the Group I and Group II comparison these values showed a significant difference. A highly significant positive correlation was observed between the TcPO2 and ABI test results in the diabetic foot patients that indicates both are complimentary tests for diabetic foot outcome prediction. Conclusion: Increased duration of diabetes, high value of Hba1c and presence of neuropathy were found to be important risk predictors for diabetic foot. Early and severe derangement of vibration perception indicated early involvement of large nerve fibers. Heat and cold perception is affected late and less severely, indicating late involvement of small nerve fibers in diabetic polyneuropathy. The positive correlation between TcPO2 and ABI indicates both are complementary tests for predicting the outcome of diabetic foot. However, TcPO2 being a better predictor maybe incorporated as a routine screening test for diabetic foot risk and outcome predictor in the diabetic foot clinic.

Fatores relacionados ao risco de feridas em pacientes com Diabetes mellitus Tipo 2 / Factors related to wound risk in patients with Type 2 Diabetes mellitus

Poucos estudos abordam as características sociodemográficas e o risco de feridas no nordeste brasileiro. O objetivo do estudo foi determinar a prevalência de risco de feridas e os fatores relacionados em pessoas com diabetes no município de Parnaíba, estado do Piauí, Brasil. Estudo transversal realizado com 300 pessoas com diabetes. Os voluntários foram avaliados por meio de questionário sociodemográfico, monofilamento de 10 g, diapasão de 128 Hz, martelo de reflexo e escala de classificação de risco de feridas. Sexo masculino (OR 2,33; IC 95% 1,22-4,42), idade (OR 1,03; IC 95% 1,01-1,05), inatividade física (OR 2,35; IC 95% 1,26-4,38) e duração maior de diabetes (OR 3,28; IC 95% 1,56-6,91) foram associados ao risco de feridas. Este estudo demonstrou um alto risco de feridas relacionado a idade, sexo feminino, duração da diabetes e inatividade física e alta prevalência de complicações como a neuropatia periférica diabética e amputações.

Few studies have addressed the sociodemographic characteristics and risk of wound development in northeastern Brazil. The objective of the study was to determine the prevalence of wound risk and the related factors in people with diabetes in the municipality of Parnaíba, Piauí State, Brazil. A cross-sectional study was conducted with 300 people with diabetes. The volunteers were assessed using a sociodemographic questionnaire, a 10 g monofilament, a 128 Hz tuning fork, a reflex hammer, and a wound risk rating scale. Male sex (OR 2.33, 95% CI 1.22-4.42), age (OR 1.03, 95% CI 1.01-1.05), physical inactivity (OR 2.35, 95% CI 1.26-4.38), and a longer duration of diabetes (OR 3.28, 95% CI 1.56-6.91) were associated with wound risk. This study demonstrated a high wound risk related to age, male sex, duration of diabetes, and physical inactivity and a high prevalence of complications such as diabetic peripheral neuropathy and amputations.

Fatores associados ao maior risco de ulceração nos pés de indivíduos com diabetes mellitus / Factors associated with the greatest risk of ulceration on the feet of individuals with diabetes mellitus

Objetivo: Diante da alta prevalência do Diabetes Mellitus, o estudo se propõe a identificar os fatores associados ao maior risco de desenvolver úlceras nos membros inferiores. Métodos: O trabalho foi exploratório-descritivo, transversal e com abordagem quantitativa. A amostra foi composta por pacientes com Diabetes acima de 18 anos de um serviço de saúde particular e um público. A coleta de dados ocorreu através de anamnese, exame físico e procura em prontuário. A análise estatística foi realizada pelo Programa SPSS 20.0. Resultados: Obteve-se 102 participantes no estudo, destes, 67,6% apresentaram critérios diagnósticos para Polineuropatia Simétrica Distal. Os fatores associados ao risco de ulceração foram: o envelhecimento, a maior duração da Diabetes, hipertensão, doença arterial periférica e a presença de sintomas típicos da Polineuropatia. Conclusão: É necessário investir na prevenção de úlceras em indivíduos com Diabetes através de educação em saúde e acompanhamento por profissionais da saúde (AU)

Objective: Given the high prevalence of Diabetes Mellitus, the study aims to identify the factors associated with a higher risk of developing ulcers in the lower limbs. Methods: The work was exploratory-descriptive, transversal and with a quantitative approach. The sample consisted of patients with Diabetes over 18 years of age from a private and a public health service. Data collection occurred through anamnesis, physical examination and search in medical records. Statistical analysis was perform using the SPSS 20.0 program. Results: 102 study participants were obtained, of wich 67,6% had diagnostic criteria for Distal Symmetric Polyneuropathy. Factors associated with the risk of ulceration were: aging, longer duration of diabetes, hypertension, peripheral arterial disease and the presence of typical symptoms of polyneuropathy. Conclusion: It is necessary to invest in the prevention of ulcers in individuals with Diabetes, through health education and monitoring by health professionals.Keywords: Diabetes Mellitus, Diabetic neuropathies, Polyneuropathies, Foot ulcer, Diabetic foot (AU)

Costos y resultados del tratamiento con Heberprot-P® en pacientes con pie diabético del Policlínico Ramón López Peña / Costs and Outcomes of Heberprot-P® Treatment in Patients with Diabetic Foot Ulcer from Ramón López Peña Polyclinic

Introducción: Las úlceras del pie diabético constituyen una de las principales causas de morbilidad y discapacidad, con una importante repercusión por la carga económica de la enfermedad y desde el punto de vista social, por la disminución de la calidad de vida de los pacientes. Objetivo: Evaluar costos y resultado del tratamiento ambulatorio con el Heberprot P® para la atención al paciente con úlcera del pie diabético. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo de 22 pacientes con pie diabético tratados con Heberprot-P®, en la consulta para tales fines del Policlínico Ramón López Peña en el año 2019. Resultados: El 63,6 por ciento de los pacientes que acudieron a consulta presentaron Pie de Riesgo grado cero; la úlcera neuroinfecciosa fue la de mayor incidencia de presentación (94,5 por ciento). Se obtuvo una efectividad del 95,4 por ciento del total de los casos tratados. La mayoría de los tratados necesitaron entre 3-8 bulbos del medicamento, con un promedio de 5 sesiones de tratamiento por paciente, a un costo promedio de $ 3 549,8 /caso tratado. Conclusiones: El tratamiento con el Heberprot P® es altamente efectivo para la cicatrización de las UPD, evitando en gran medida las amputaciones de los miembros inferiores de los pacientes con diabetes mellitus, con una consiguiente disminución del costo económico que tienen estas intervenciones sanitarias para el país(AU)

Introduction: Diabetic foot ulcer is one of the main causes of morbidity and disability, with an important repercussion due to the economic burden of the disease and from the social point of view, due to the decrease in patients' quality of life. Objective: To assess costs and outcomes of outpatient treatment with Heberpro-P® for the care of patients with diabetic foot ulcers. Methods: A descriptive, longitudinal and retrospective study was carried out of 22 patients with diabetic foot treated with Heberprot-P®, in the consultation for such purposes of Ramón López Peña Polyclinic in 2019. Results: 63.6 percent of the patients who came for consultation presented zero risk foot; neuroinfectious ulcer was the one with the highest incidence of presentation (94.5 percent). An effectiveness rate of 95.4 percent of the total of treated cases was obtained. Most of those treated needed three to eight bulbs of the medication, with an average of five treatment sessions per patient, at an average cost of 3549.8 Cuban pesos per treated case. Conclusions: Treatment with Heberprot-P® is highly effective for the healing of diabetic foot ulcers, largely avoiding amputations of lower limbs of patients with diabetes mellitus, with a consequent decrease in the economic cost of these health interventions for the country(AU)

Fatores associados ao maior risco de ulceração nos pés de indivíduos com diabetes mellitus / Factors associated with the greatest risk of ulceration on the feet of individuals with diabetes mellitus

RESUMO: Objetivo: Diante da alta prevalência do Diabetes Mellitus, o estudo se propõe a identificar os fatores associados ao maior risco de desenvolver úlceras nos membros inferiores. Métodos: O trabalho foi exploratório-descritivo, transversal e com abordagem quantitativa. A amostra foi composta por pacientes com Diabetes acima de 18 anos de um serviço de saúde particular e um público. A coleta de dados ocorreu através de anamnese, exame físico e procura em prontuário. A análise estatística foi realizada pelo Programa SPSS 20.0. Resultados: Obteve-se 102 participantes no estudo, destes, 67,6% apresentaram critérios diagnósticos para Polineuropatia Simétrica Distal. Os fatores associados ao risco de ulceração foram: o envelhecimento, a maior duração da Diabetes, hipertensão, doença arterial periférica e a presença de sintomas típicos da Polineuropatia. Conclusão: É necessário investir na prevenção de úlceras em indivíduos com Diabetes através de educação em saúde e acompanhamento por profissionais da saúde. (AU)

ABSTRACT: Objective: Given the high prevalence of Diabetes Mellitus, the study aims to identify the factors associated with a higher risk of developing ulcers in the lower limbs. Methods: The work was exploratory-descriptive, transversal and with a quantitative approach. The sample consisted of patients with Diabetes over 18 years of age from a private and a public health service. Data collection occurred through anamnesis, physical examination and search in medical records. Statistical analysis was perform using the SPSS 20.0 program. Results: 102 study participants were obtained, of wich 67,6% had diagnostic criteria for Distal Symmetric Polyneuropathy. Factors associated with the risk of ulceration were: aging, longer duration of diabetes, hypertension, peripheral arterial disease and the presence of typical symptoms of polyneuropathy. Conclusion: It is necessary to invest in the prevention of ulcers in individuals with Diabetes, through health education and monitoring by health professionals. (AU)

Melanoma amelanótico acral / Acral amelanotic melanoma

O melanoma amelanótico acral é raro e pode mimetizar muitas entidades, como poroma écrino, carcinoma de células escamosas, verruga plantar e úlceras crônicas. Devido a esta variedade de possíveis diagnósticos diferenciais, é um diagnóstico difícil e, muitas vezes, tardio. As características da dermatoscopia podem ajudar no diagnóstico precoce. O clínico deve ter esse diagnóstico em mente ao se deparar com uma lesão rosada, de crescimento progressivo e formato irregular, principalmente se localizada nas mãos e nos pés.

Acral amelanotic melanoma is rare and can mimic many entities, such as eccrine poroma, squamous cell carcinoma, plantar wart, and chronic ulcers. Due to the variety of possible differential diagnoses, it is a challenging and frequently late diagnosis. Dermoscopy features can help in early diagnosis. The dermatologist should keep this diagnosis in mind when faced with a pink, progressively growing, irregularly shaped lesion, mainly if located on the hands and feet.

Rastreamento de risco de ulceração nos pés em participantes de campanhas de prevenção e detecção do diabetes mellitus / Rastreo de riesgo de ulceración en los pies de participantes de campañas de prevención y de detección de diabetes mellitus / Foot ulcer risk screening in prevention campaign participants and detection of diabetes mellitus

Resumo Objetivo Analisar as características clínicas e sociodemográficas relacionadas ao rastreamento de risco de ulcerações nos pés em participantes de campanhas de detecção do diabetes mellitus. Métodos Estudo seccional conduzido durante campanhas de detecção do diabetes mellitus realizadas pela Associação Nacional de Assistência ao Diabético ANAD, entre 2013 e 2017, na cidade de São Paulo para a detecção do risco de ulceração nos pés segundo variáveis demográficas e clínicas. A população do estudo foi composta por pessoas com ou sem diagnóstico prévio de diabetes. Os instrumentos de coleta utilizados foram a entrevista e o exame físico específico dos pés dos participantes. Aplicaram-se cálculos das medidas referentes às variáveis qualitativas e testes do qui quadrado e Exato de Fisher. Resultados Um total de 2.110 pessoas foram analisadas, a maioria do sexo feminino, média de idade de 64 anos, ensino fundamental, predominância de diabetes mellitus tipo 2. Identificou-se associação entre os graus de risco de ulcerações nos pés e duração da doença (p=0,021), ausência de higiene nos pés (p=0,029), pele ressecada, alteração da sensação protetora plantar, pulsos periféricos ausentes, presença de onicomicose, deformidades, úlcera e amputação (p<0,001) e 65,5% dos participantes referiram não ter recebido orientações prévias para os cuidados com os pés. Conclusão Os sinais de risco para ulcerações nos pés durante as campanhas de detecção do diabetes foram identificados e contribuem para o rastreamento das complicações e se constituem em estratégias para as ações de prevenção realizadas por estudantes de extensão acadêmica.

Resumen Objetivo Analizar las características clínicas y sociodemográficas relacionadas al rastreo de riesgo de ulceraciones en los pies de participantes de campañas de detección de diabetes mellitus. Métodos Estudio seccional conducido durante campañas de detección de diabetes mellitus realizadas por la Asociación Nacional de Atención al Diabético ANAD, entre 2013 y 2017, en la ciudad de São Paulo, para la detección del riesgo de ulceración en los pies de acuerdo con variables demográficas y clínicas. La población del estudio estuvo compuesta por personas con o sin diagnóstico previo de diabetes. Los instrumentos utilizados para la recopilación fueron la entrevista y el examen físico específico de los pies de los participantes. Se aplicaron cálculos de las medidas referentes a las variables cualitativas y pruebas de Ji cuadrado y Exacta de Fisher. Resultados Se analizaron un total de 2.110 personas, en su mayoría del sexo femenino, promedio de edad de 64 años, educación primaria, predominio de diabetes mellitus tipo 2. Se identificó una asociación entre los grados de riesgo de ulceraciones en los pies y la duración de la enfermedad (p=0,021), la ausencia de higiene en los pies (p=0,029), piel seca, alteración de la sensación protectora plantar, pulsos periféricos ausentes, presencia de onicomicosis, deformidades, úlcera y amputación (p<0,001). El 65,5 % de los participantes mencionó no haber recibido orientaciones previas sobre los cuidados de los pies. Conclusión Se identificaron las señales de riesgo de ulceraciones en los pies durante las campañas de detección de diabetes. Esto contribuye al rastreo de complicaciones y se refleja en estrategias para las acciones de prevención realizadas por estudiantes de extensión académica.

Abstract Objective To analyze the clinical and sociodemographic characteristics related to foot ulcer risk screening in participants of diabetes mellitus detection campaigns. Methods This is a cross-sectional study conducted during diabetes mellitus detection campaigns carried out by the Brazilian National Association for Diabetic Care (ANAD - Associação Nacional de Atenção ao Diabetes), between 2013 and 2017, in the city of São Paulo, to detect foot ulceration risk according to demographic and clinical variables. The study population consisted of people with or without a previous diagnosis of diabetes. The collection instruments used were the interview and the specific physical examination of participants' feet. Measurements relating to qualitative variables and chi-square and Fisher's exact tests were applied. Results We assessed 2,110 people, most of them female, mean age of 64 years, complete elementary school, predominance of type 2 diabetes mellitus. An association was identified between the degrees of foot ulcer risk and disease duration (p=0.021), lack of foot hygiene (p=0.029), dry skin, change in plantar protective sensation, absent peripheral pulses, presence of onychomycosis, deformities, ulcer and amputation (p<0.001), and 65.5% of participants reported not having received previous guidance for foot care. Conclusion The signs of foot ulceration risk during diabetes detection campaigns were identified and contributed to screening complications, being strategies for prevention actions carried out by academic extension students.

Plasma rico en plaquetas autólogo tópico para el tratamiento de la úlcera de pie diabético / Autologous platelet rich plasma for the treatment of diabetic foot ulcer

Background: Diabetic foot ulcer is one of the frequent complications of diabetes. 15% to 25% develop ulcers at some point in their lives. The existing evidence on the efficacy of topical autologous platelet-rich plasma (PRP) for the treatment of diabetic foot ulcers was assessed. Method: A search for randomized controlled clinical trials comparing autologous topical PRP vs standard care and placebo was carried out in Pubmed, Cochrane, Lilacs, and Clinical Trials databases. For dichotomous outcomes, relative risk analysis, 95% CI, and the Mantel-Haenszel method were used; for continuous outcomes, the mean difference and inverse variance method were calculated. Results: The result of the search was 153 studies, 28 duplicates were excluded, 59 by title and abstract, and 52 by reading the article. 14 studies were included in the review, 8 for qualitative review and 6 for quantitative. Six studies with a complete ulcer-healing outcome at the end of the intervention were evaluated, out of a total of 415 participants (relative risk 1.24 CI [1.11, 1.40]). The outcome epithelialized area at the end of the intervention, measured in cm², was not reported. A single study measured quality of life and pain. Conclusion: There is evidence of the beneficial effect of topical autologous PRP for the healing of diabetic foot ulcers, however, studies of higher methodological quality, greater production of clinical trials in Latin America, and assessment of the quality of life and pain are needed.

Antecedentes: La úlcera de pie diabético constituye una de las complicaciones frecuentes de la diabetes. Del 15% al 25% de los pacientes presentan úlceras en algún momento de su vida. Se valoró la evidencia existente sobre la eficacia del plasma rico en plaquetas (PRP) autólogo tópico para el tratamiento de úlcera de pie diabético. Método: Se llevó a cabo a partir de datos de Pubmed, Cochrane, Lilacs y Clinical Trials, búsqueda de ensayos clínicos aleatorizados controlados que compararon PRP autólogo tópico frente a cuidados estándar y placebo. Para los resultados dicotómicos se usó el análisis de riesgo relativo, con intervalos de confianza del 95% y el método de Mantel-Haenszel; para los resultados continuos, se calculó la diferencia de medias y método de varianza inversa. Resultados: El resultado de la búsqueda fue 153 estudios, se excluyeron 28 duplicados, 59 por título y abstract y 52 por lectura de artículo. Se incluyeron 14 trabajos en la revisión, 8 para revisión cualitativa y 6 para cuantitativa. Se valoraron 6 estudios con desenlace de curación completa de úlcera al final de la intervención, sobre un total de 415 participantes (riesgo relativo 1.24 [IC 95%: 1.11 a 1.40]). No se informó el desenlace área epitelizada al final de la intervención medida en cm². Un solo estudio midió calidad de vida y dolor. Conclusión: Existe evidencia del efecto beneficioso del PRP autólogo tópico para la curación de úlcera de pie diabético; no obstante, se necesitan estudios de mayor calidad metodológica, mayor producción de ensayos clínicos en Latinoamérica y valoración de calidad de vida y dolor.

Purified novel and new diferuloyl glycerate related phenolic acid from Pandanus odoratissimus flowers shows antioxidant, invertase inhibition and control against diabetic foot ulcer (DFU) causing bacterial pathogens - An in vitro study to establish an effective regulation over type 2 diabetes mellitus

Abstract Chronic type 2 diabetes mellitus (T2DM) and its associated diseases are major concern among human population and also responsible for significant mortality rate. Hence, the present study aims to evaluate and correlate the invertase inhibition, antioxidant activity and control against DFU causing bacterial pathogens by Pandanus odoratissimus flowers. Two dimensional preparative thin layer chromatography (2D PTLC) was adopted to purify the phenolic acid component and LC-MS2 was done to predict the phenolic acid structures. Standard spectrophotometry methods were adopted to investigate the in vitro invertase inhibitory and antioxidant (CUPRAC and ABTS) activities. Agar well diffusion and broth dilution assays were used to record the antibacterial property against DFU causing pathogens isolated from clinical samples. Statistical analyses were used to validate the experiments. A new and novel diferuloyl glycerate related phenolic acid (m/z 442) purified from PTLC eluate has recorded satisfactory cupric ion reducing power (ED50= 441.4±2.5 µg), moderate ABTS radical scavenging activity (IC50= 450.3±10 µg; 32.5±1.5%), and a near moderate, in vitro, invertase mixed type inhibition (24.5±4.5%; Ki: 400 µg). Similarly, bacterial growth inhibitory kinetics has showed a significant inhibition against E. coli and S. aureus.

Clinical characteristics and risk factors of lower extremity arterial disease in patients with diabetic foot ulcer / 南方医科大学学报

OBJECTIVE@#To investigate the clinical characteristics of lower extremity arterial disease (LEAD) and its risk factors in patients with diabetic foot ulcer (DFU).@*METHODS@#We retrospectively collected the clinical and follow-up data of 650 patients with DFU treated in the Department of Endocrinology and Metabolism of Nanfang Hospital between January, 2017 and December, 2019. We compared the data between patients who had LEAD and those without LEAD and used a multivariate logistic regression model to analyze the risk factors of LEAD in DFU patients.@*RESULTS@#Among the 650 DFU patients, 470 (72.4%) had LEAD. The patients were followed up for a mean of 3.5 months, and the mean healing time of DFU was 2.55 months; healing of DFU occurred in 453 patients and 183 patients received amputation. The patients with LEAD and those without LEAD differed significantly in age, hospitalization costs, diastolic blood pressure (DBP), glycated hemoglobin, blood lipid levels, disease course, ankle brachial index, healing time, smoking history, clinical outcomes, Wagner grade and imaging results (P < 0.05). Multivariate logistic regression analysis identified age (OR=1.070, 95% CI: 1.049-1.091), smoking history (OR= 2.013, 95% CI: 1.268-3.195), and a decreased DBP (OR=0.980, 95% CI: 0.963-0.997) as independent risk factors for LEAD in DFU patients. A prolonged healing time was a prominent clinical feature of DFU complicated by LEAD.@*CONCLUSION@#DFU patients have a high incidence of LEAD, which leads to high rates of disability and mortality and is associated with an advanced age, high smoking rate and longer healing time. A decreased DBP is also a risk factor for LEAD in DFU patients.